Role of Serum Interleukin-6, Interleukin-1β and Interleukin-10 in Assessment of Disease Activity and Nutritional Status in Patients with Inflammatory Bowel Disease

Inflammatory bowel diseases (IBD) are characterised by multifactorial and chronic inflammation. Much attention has been paid to immune dysfunction in inflammatory bowel diseases. The aim of this study was to assess the usefulness of serum IL-6, IL-1β and IL-10 in determining the activity and nutritional status in IBD patients. The case-control study was carried out on 82 patients with IBD; the control group consisted of 25 clinically healthy subjects. The serum concentrations of IL-6, IL-1 β and IL-10 were determined by the quantitative sandwich enzyme-linked immunosorbent assay. There were no significant differences in IL-6 and IL-1β levels in UC and CD patients according to disease activity as assessed by the Montreal classification, Partial Mayo Score and CDAI. Significantly higher IL-6 levels were found in patients with low body fat in comparison to patients with normal body fat. Furthermore, significantly higher mean IL-6 levels were observed in patients with excess body fat in comparison to patients with normal body fat, and also in comparison to patients with deficient body fat. IL-6 and IL-1β may provide extra information regarding the nutritional status of IBD patients. IL-10 can be considered a non-invasive biomarker of IBD activity.

Indirect and Direct 65+ Patient Reporting of Non-Steroidal Anti-Inflammatory Drug-Induced Adverse Drug Reactions as a Source of Information on Polypharmacy and Polypharmacy-Related Risk

Background and Objectives: Non-steroidal anti-inflammatory drugs (NSAIDs), which have anti-inflammatory and analgesic properties, are commonly used in the treatment of various, particularly frequent, as well as chronic, conditions in older patients. Due to common polypragmasia in these patients and a high risk of adverse drug reactions (ADRs) and drug interactions, pain management poses a therapeutic challenge. This study describes the importance of ADR reports in the identification of polypharmacy and the ensuing interactions. Materials and Methods: Both healthcare professionals (HPs) and non-healthcare professionals (non-HPs) reports collected in the EudraVigilance database of NSAIDs, including most commonly co-reported medications and reported reactions, were analysed and differences between HPs and non-HPs reports were identified. Results: In the analysed period and group, non-HPs reported more reactions but indicated fewer drugs as suspect or concomitant. The outcomes of our analysis indicate more HP engagement and more detailed reports of serious ADRs when compared to non-serious individual case safety reports (ICSRs) by non-HPs, which appeared more detailed. Such reactions as kidney failure and increased risk of bleeding are known adverse reactions to NSAIDs and common symptoms of their interactions, which were described in the available literature. They were much more frequently reported by HPs than by non-HPs. Non-HPs more frequently reported reactions that may have been considered less significant by HPs. Conclusions: The differences between healthcare professionals' (HPs) and non-healthcare professionals' (non-HPs) reports may result from the fact that the reports from patients and their caregivers require a professional medical diagnosis based on symptoms described by the patient or additional diagnostic tests. This means that when appropriately classified, medically verified, and statistically analysed, the data may provide new evidence for the risks of medication use or drug interactions.

Evaluation of Albumin, Transferrin and Transthyretin in Inflammatory Bowel Disease Patients as Disease Activity and Nutritional Status Biomarkers

Inflammatory bowel disease (IBD), which includes Crohn's disease (CD) and ulcerative colitis (UC), is often accompanied by malnutrition that manifests itself as nutrient deficiencies and body mass loss or deficit. The purpose of this study is to evaluate the utility of albumin, transferrin and transthyretin levels in the assessment of nutritional status and IBD activity. The case-control study included 82 IBD patients. The serum concentrations of albumin, transferrin and transthyretine were determined by a quantitative sandwich enzyme-linked immunosorbent assay (ELISA). Significantly lower median concentrations of albumin were found in the IBD patients vs. controls and in CD patients compared to the UC patients. Significantly higher median transthyretin concentrations were found in the IBD patients compared to the healthy subjects. There were no significant differences in median transferrin concentrations between the IBD patients and the healthy subjects. Significantly higher albumin levels were found in IBD patients in remission compared to patients with moderate and severe exacerbation of IBD symptoms. There were no significant differences in the median transferrin or transthyretin levels in patients with IBD depending on disease activity. No differences were identified in the median transferrin or transthyretin levels in the IBD patients according to nutritional status. The median albumin concentrations in the IBD subjects were significantly higher in patients with normal body fat, normal BMI and normal waist circumferences compared to those with an abnormal nutritional status. The albumin levels reflect both nutritional status and disease activity and therefore cannot be considered a prognostic marker of malnutrition in IBD. As regards the utility of transferrin and transthyretin as markers of activity and nutritional status in IBD patients, further studies are required.

Clostridioides difficile Infections among Pediatric Patients Hospitalized at an Oncology Department of a Tertiary Hospital in Poland

Background and Objectives: Gastrointestinal tract infections caused by Clostridioides difficile bacteria are diagnosed in pediatric patients with increasing frequency. Children treated at pediatric units are a group of patients at high risk of this infection; therefore, appropriate differential diagnostics and an individual approach to every case are of particular importance. The goal of the study was to assess the clinical parameters of patients with a confirmed CD infection and colonization. Materials and Methods: Every positive case was subjected to a retrospective analysis based on medical history and an infection notification note. Results: Positive results were obtained for 30 patients, among whom the results of 18 patients were considered to justify the diagnosis of an infection. In the remaining patients, treatment was not initiated in only three cases. Cases were detected where treatment was initiated despite the lack of sufficient clinical evidence. Conclusions: This study demonstrates that there are many factors that result in a high risk of the occurrence of CDI in oncology patients, such as antibiotic therapy, multiple hospitalizations, and myelosuppression.

Dietary Behaviors and Beliefs in Patients with Inflammatory Bowel Disease

INTRODUCTION

Due to a lack of clear dietary guidelines, patients with inflammatory bowel disease (IBD) self-impose dietary restrictions based on their own nutritional experiences. The aim of this study was to investigate dietary perceptions and behavior in IBD patients.

MATERIALS AND METHODS

A total of 82 patients (48 with Crohn's disease and 34 with ulcerative colitis) participated in this prospective, questionnaire-based study. Based on a literature review, the questionnaire was developed to investigate dietary beliefs, behaviors and food exclusions during IBD relapses and remission.

RESULTS

The majority of patients (85.4%) believed that diet can be a trigger factor for IBD relapses, and 32.9% believed that diet initiates the disease. The majority of patients (81.7%) believed that they should eliminate some products from their diets. The most often-pointed-out products were spicy and fatty foods, raw fruits and vegetables, alcohol, leguminous foods, cruciferous vegetables, dairy products and milk. Most patients (75%) modified their diets after diagnosis, and 81.7% imposed food restrictions to prevent IBD relapses.

CONCLUSIONS

The majority of patients avoided certain foods during relapses as well as to maintain remission of IBD, basing this on their own beliefs, inconsistently with current scientific knowledge. Patient education should be a key determinant in IBD control.

The Hospital Environment as a Potential Source for Clostridioides difficile Transmission Based on Spore Detection Surveys Conducted at Paediatric Oncology and Gastroenterology Units

Clostridioides difficile is an anaerobic, Gram-positive bacterium widely present in the hospital environment due to its ability to generate spores. The transfer of spores to patients through the hands of medical personnel is one of the most frequent paths of C. difficile transmission. In paediatric patients burdened with a serious primary illness requiring long-term hospitalisation and antibiotic therapy, C. difficile may be a significant risk factor for antibiotic-associated diarrhoea. The goal of the study was to assess the state of hospital environments as a potential source of C. difficile spores and to establish the share of hyperepidemic strains at the two paediatric units. The survey for C. difficile was conducted with a C. diff Banana BrothTM medium, used to detect spores and to recover vegetative forms of the bacteria. Environmental samples (n = 86) and swabs from the clothing of medical personnel (n = 14) were collected at two units of a paediatric hospital, where the cases of antibiotic-associated diarrhoea with a C. difficile aetiology constitute a significant clinical problem. In 17 samples, a change in the broth's colour was observed, indicating the presence of spores. Out of seven samples, C. difficile strains were cultured. The pathogenic isolates of C. difficile were obtained from swabs collected from elements of beds, a toilet, a door handle and a doctor's uniform. In our study, we indicated points of increased risk of pathogen transmission, which could constitute a source of infection. The clothing of medical personnel may be a dangerous carrier of pathogenic spores. Periodical surveys of hospital environments with the use of specialist microbiological mediums successfully indicate the direction of corrective actions to be undertaken by the medical facility in order to increase patient safety.

Dietary Behaviors, Serum 25(OH)D Levels and Quality of Life in Women with Osteoporotic Disorders

Data obtained in recent years clearly demonstrate the aging process of European populations. Consequently, the incidence of osteoporosis has been rising. The aim of this study is to assess the quality of life (QoL) of women with osteoporosis. A total of 260 women participated in this study. The patient group consisted of 170 women with osteoporotic disorders. The control group consisted of 90 healthy women. Participants' quality of life was measured with the Qualeffo-41 Questionnaire. The total 25(OH)D concentration level was assessed with an assay using the chemiluminescent immunoassay. To assess the pain level, the Visual Analogue Scale (VAS) was used. To assess dietary behaviors, data were obtained by a 13-item Food Frequency Questionnaire. To assess the nutrition knowledge of participants, the Beliefs and Eating Habits Questionnaire was used. Based on the frequency of food intake, participants were classified into three patterns of behavior, i.e., Prudent, Western, and Not Prudent-Not Western. The patients assessed their quality of life as average (36.6 ± 19.9 points). The most favorable scores were obtained in the domains of "Ability to do jobs around the house" and "Mobility". The worst rated domain among the respondents was "Mental function". There were significant differences identified in quality of life depending on diet, nutritional knowledge, comorbidities and occurrence of fractures in the subjects. The individuals in the "Prudent" group reported a significantly higher quality of life as compared to the "Not Prudent-Not Western" and "Western" groups and those with high nutritional knowledge as compared to those with moderate and low. Lower quality of life was also observed among women with comorbidities and with bone fractures. Depending on serum 25(OH)D levels, poorer quality of life was characterized women with vitamin D deficiency. Patient education, implementation of effective methods aimed at alleviating pain and maintaining the optimal concentration of vitamin D can help improve the quality of life in patients with osteoporotic disorders.

The Scale of Intoxications with New Psychoactive Substances over the Period 2014-2020-Characteristics of the Trends and Impacts of the COVID-19 Pandemic on the Example of Łódź Province, Poland

Legal highs are new psychoactive substances (NPSs) which pose a high risk for human health, and the spread of the SARS-CoV-2 pandemic has changed peoples’ behaviours, including the demand for NPS. The aim of the study was to assess both the frequency of intoxication with NPS in Łódź province over the period 2014−2020, and the impact of the COVID-19 pandemic on developing this trend. An analysis was carried out of data on intoxications in Łódź province in the years 2014−2020 reported by hospitals. The medical interventions rate (MI) per 100,000 people in the population was calculated. The frequency of intoxications was compared taking sociodemographic variables into account, and the effect of seasonal influence on intoxications was calculated using the Holt−Winter multiplicative seasonal method. In the period considered, there were 7175 acute NPS poisonings in the Łódź province and 25,495 in Poland. The averaged MI rate between 2014−2020 was 9.45 for Poland and 38.53 for the Łódź province, and the lowest value was found during the COVID pandemic in the year 2020 (respectively, 2.1 vs. 16.94). NPS users were mainly young men of 19−24 years old from a big city. Most cases were registered at weekends and in summer months. The majority of intoxications were caused by unidentified psychoactive substances of legal highs (chi2 = 513.98, p < 0.05). The actual number of NPS-related poisonings in the Łódź province in 2020 was lower than the value extrapolated from trend analysis of data between 2014−2019. NPS use in Poland decreased during the pandemic. It should be noted that a decrease in the number of drug-related incidents can have more than one reason, e.g., preventive programs, increased awareness, or changes in the law. This paper advocates that, in addition to monitoring NPS-related intoxications, there is further investigation into the social, cultural, and behavioural determinants of NPS to facilitate targeted prevention programmes and the development of new medical treatments.

Resting Metabolic Rate in Women with Endocrine and Osteoporotic Disorders in Relation to Nutritional Status, Diet and 25(OH)D Concentration

There are speculations that vitamin D may be an important regulator of the energy metabolism. The aim of this study was to evaluate the influence of serum 25(OH)D concentration and nutritional status on the resting metabolic rate. The study group consisted of 223 women with endocrine and/or osteoporotic disorders. The control group consisted of 108 women, clinically healthy. The total 25(OH)D concentration level was measured with an assay using chemiluminescent immunoassay technology. Indirect calorimetry was applied to assess the resting metabolic rate. The mean resting metabolic rate was significantly lower in the group of women with metabolic disorders than in the control group. A correlation was found between serum 25(OH)D levels in healthy subjects and the resting metabolic rate. Significantly higher resting metabolic rate was found in women with normal serum 25(OH)D levels in comparison to subjects with deficient vitamin D levels. The control group demonstrated a relationship between body fat tissue and fat-free body mass and the resting metabolic rate. Both 25(OH)D concentration and body composition were factors influencing the resting metabolic rate in the group of healthy subjects. More research is needed to clarify the relationship between vitamin D status and metabolic rate in individuals with endocrine and osteoporotic disorders.

Vitamin D status in Polish women with endocrine and osteoporotic disorders in relation to diet, supplement use and exposure to ultraviolet radiation

BACKGROUND

In Europe, the rate of 25(OH)D deficiency is considered high. Thus, it seems necessary to conduct population-based studies to fully assess vitamin D deficiency in various groups of patients.

OBJECTIVES

To evaluate serum 25(OH)D levels and the frequency of deficiency in women in Poland with endocrine and osteoporotic disorders. The influences of diet, use of vitamin/mineral supplementation and exposure to ultraviolet (UVB) radiation on vitamin D status in women with metabolic disorders were also examined.

MATERIAL AND METHODS

The patient group consisted of 223 women aged 19-81 years diagnosed with endocrine and/or osteoporotic disorders. The control group consisted of 108 clinically healthy women aged 26-72 years. Serum 25(OH)D concentration was assessed using a chemiluminescent immunoassay (CLIA). An ad hoc questionnaire was used to assess the participants' exposure to UVB radiation. Food intake was assessed using a three-day 24-hour questionnaire interview.

RESULTS

The following groups showed significantly higher 25(OH)D levels: women taking vitamin D supplements compared to women not taking vitamin D supplements (29.3 ±3.2 compared to 19.5 ±3.7 ng/mL, p = 0.0024); premenopausal women compared to postmenopausal women (28.9 ±5.2 compared to 21.5 ±4.5 ng/mL, p = 0.0021); women who visited sunny countries in the last 6 months compared to women who did not (28.1 ±3.1 ng/mL compared to 24.5 ±5.3 ng/mL, p = 0.0031); and normal weight or overweight women (according to body mass index (BMI)) compared to obese women (27.4 ±4.5 ng/mL compared to 22.3 ±4.7 ng/mL, p = 0.0431). In addition, 25(OH)D concentration correlated with total dietary vitamin D intake in the patient group (R = 0.17, p = 0.0021). Of all examined food groups, fish consumption affected serum 25(OH)D levels in patients (R = 0.20, p = 0.0421) and controls (R = 0.29, p = 0.0002). Consumption of fish products contributed to statistical differences between the patient group (R = 0.17, p = 0.0072) and healthy subjects (R = 0.19, p = 0.0032).

CONCLUSIONS

The most crucial factors influencing vitamin D status in the studied women were regular fish consumption, spending holidays in sunny destinations and regular intake of vitamin D preparations.

[Surgery first as an alternative approach in patients treated for dentofacial deformities]

Recently surgery first became more popular alternative for treatment of dentofacial deformities. In this approach treatment starts from orthognathic surgery. Immediately after othognathic surgery facial aesthetics and oral function are improved. Thus main complaints of the orthognathic patients are resolved early during treatment period. Indications for surgery first approach are wider than years ago and include: skeletal Class II and III malocclusion, skeletal open bite, bimaxillary protrusion, even cases with severe facial asymmetry are reported. The key point for gaining stable results and total treatment time shortening is an appropriate surgical occlusion. For higher precision of treatment 3D virtual planning is recommended. Total treatment time depends on: number of contact points in surgical occlusion, number of extracted teeth and postsurgical midline deviation. Surgery first is a good alternative approach in some patients treated for dentofacial deformities. Stability in this approach is similar to conventional method of treatment and both methods result in quality of life improvement. As there is lack of presurgical orthodontics in surgery first approach patients avoid transient deterioration in facial aesthetics and oral function that results in higher satisfaction and shorter total treatment time.

Assessment of cardiovascular risk in patients with metabolic syndrome working in the agricultural sector

INTRODUCTION

Cardiovascular diseases are the main death cause in Poland. Several clinical studies showed association between metabolic syndrome and higher prevalence of diabetes mellitus, cardiac events and mortality. The aim of the study was to estimate cardiovascular complications and death risk in subjects with metabolic syndrome (MS) working in agriculture.

MATERIAL AND METHODS

The study included 332 people working in agriculture in Lodz voivodeship, 231 with MS and 101 healthy ones. Increased risk of cardiovascular complications was determined for pulse pressure (pp) >63 mmHg. Based on the SCORE index, 10-year death risk due to cardiovascular complications was estimated taking into account sex, age, smoking, systolic blood pressure and total cholesterol concentration. A value ≥5% was accepted as high risk of death within 10 years.

RESULTS

Increased risk of cardiovascular complications (pulse pressure >63 mmHg) was found in 31.60% subjects with MS and 6.93% healthy ones.

CONCLUSIONS

High risk of cardiovascular complications and death occurs statistically more frequently in subjects with MS than in the rest of the population.

[An assessment of the antioxidant vitamins concentration in people with metabolic syndrome working in agriculture]

BACKGROUND

Vitamins A, C and E are important parts of the antioxidant barrier. Polish data on antioxidant vitamins deficiency in the population are rare, especially among physically active people with metabolic disorders. The aim of this study was to evaluate the serum concentrations of vitamins A, C and E in people with metabolic syndrome (MS) working in agriculture, the prevalence of their deficiency in these workers, and the correlation between antioxidant vitamins concentration and traditional biomarkers of cardiovascular diseases.

MATERIAL AND METHODS

The study included 332 residents of the Łódź Voivodeship working in agriculture: 231 people with MS and 101 healthy ones. The serum concentrations of vitamins A, C and E were assessed using the chemiluminescent immunoassay technology. The antioxidant vitamins intake was assessed by means of a 24-h recall questionnaire using Diet 5.0 software.

RESULTS

The mean serum concentrations of vitamins A, C and E were significantly lower in the MS workers than in the healthy ones No correlation was found between the antioxidant vitamins concentration and the dietary intake but there was a correlation between the antioxidant vitamins concentration and high-density lipoprotein cholesterol (HDL-C). A correlation was found between the serum concentrations of vitamins A and C, and vitamins A and E, in the MS workers.

CONCLUSIONS

The serum concentrations of antioxidant vitamins in the MS workers were significantly lower than in the healthy controls, despite the similar physical activity level. The dietary intake had no impact on the serum concentrations of these vitamins. The HDL-C concentration in the MS workers correlated with the concentrations of all antioxidant vitamins. Med Pr. 2021;72(2):123-9.

[Assessment of 25(OH)D concentration in people with metabolic syndrome working in agriculture]

BACKGROUND

Polish data on vitamin D deficiency in the population are incomplete. Vitamin D deficiency seems to be common, but there is a lack of studies concerning the concentration of 25(OH)D in people with high UV exposure. The aim of this study was to evaluate the plasma concentration of 25(OH)D in people with and without metabolic syndrome (MS), working in agriculture, the prevalence of its deficiency in these workers, and the correlation between the plasma concentration of 25(OH)D and traditional biomarkers of cardiovascular diseases.

MATERIAL AND METHODS

The study included 332 people working in agriculture in the Łódź voivodeship, including 231 people with MS and 101 healthy ones. The plasma concentration of 25(OH)D was assessed using the chemiluminescent immunoassay technology. The vitamin D intake was assessed using a 24-h recall questionnaire using Diet 5.0 software.

RESULTS

The mean plasma concentration of 25(OH)D was 13.64±8.01 ng/ml in MS workers, and it was significantly lower than in the healthy ones (26.61±10.12 ng/ml, p < 0.00001); the highest concentration of 25(OH)D was noted in summer months. Deficient plasma concentrations of 25(OH)D were found significantly more often in MS workers than in the controls (81.82% and 20.79%, respectively, p < 0.00001). No correlation was found between the plasma vitamin D concentration and its dietary intake. The plasma concentration of 25(OH)D correlated with age of the examined workers (r = -0.28, p = 0.023), high density lipoprotein concentration (r = 0.19, p = 0.036) and glucose concentration (Rho = -0.24, p = 0.02). A multivariate analysis of variance demonstrated that the body mass index affected significantly the mean value of the 25(OH)D concentration in MS workers.

CONCLUSIONS

The concentration of vitamin D in the plasma of workers with MS was significantly lower than in the healthy controls despite the same high UV exposure; these workers also manifested significantly higher 25(OH)D deficiency than the control subjects. This study indicates the need for further research on the concentration of 25(OH)D in people with metabolic disorders regardless of UV exposure and vitamin D intake with a diet. Med Pr. 2021;72(1):9-18.

Circumstances and Structure of Occupational Sharp Injuries among Healthcare Workers of a Selected Hospital in Central Poland

(1) Background: An analysis of work-related sharp injuries in Healthcare Workers (HCWs) based at a selected hospital in Central Poland by presenting the frequency of accidents, injury rates, and identifying circumstances of Needle Sticks and Sharp Injuries (NSSI) and giving Post-Exposure Procedures (PEP). (2) Methods: A retrospective analysis of medical documentation regarding work-related NSSI at a district hospital located in central Poland; over the period 2010⁻2017. The study group included HCWs who had an accident while on duty. (3) Results: Most injuries were reported by nurses and staff over 40, on the morning shift. The most common injuries were using a needle. The most exposed part of the body were fingers. The average annual injury rates were: 1.22/100 Nurses; 2.02/100 doctors; 1.34/100 hospital beds; and 8.59/100,000 inpatient days. The rates for 3-year periods, after the implementation of legal regulations were higher than before.

CONCLUSION

Injuries rates are more reliable for comparison than frequency. Legislation on the need to register injuries seems to be necessary. In the supervision of work safety of personnel, reliable reporting of all injuries by the respective HCWs plays a key role.

Occupational Safety and Hygiene of Dentists from Urban and Rural Areas in Terms of Sharp Injuries: Wound Structure, Causes of Injuries and Barriers to Reporting-Cross-Sectional Study, Poland

(1) Background: Frequent contact of the dentist with potentially infectious material (PIM) is undeniable. The aim of the study was to determine the frequency and type of injuries, as well as to identify barriers to reporting and barriers to the implementation of post-exposure prophylaxis (PEP) among dentists from urban and rural areas. (2) Methods: We surveyed 192 dentists using an anonymous questionnaire. (3) Results: During the 12 months preceding the survey, 63% of dentists from the village and 58.8% of dentists from the city suffered at least one superficial cut, and deep cuts 15.1% and 17.6% respectively. Contact with PIM through spitting on the conjunctiva was 58.9% and 52.1% (village vs. city). Needle stick injuries were 50.4% and fingers were affected in 48.8% cases. The causes of injuries were: inattention 54.7%, rush 27%, unpredictable behavior of the patient 19%, recapping 18.2%. Work in the countryside was associated with a 1.95-times greater chance of not reporting injuries. The distance from a hospital with antiretroviral treatment may be a barrier to the implementation of PEP. (4) Conclusion: The circumstances of the injuries and the reasons for not applying for antiretroviral treatment point to the areas of necessary dentist education in this topic.

Gender, age, social disadvantage and quitting smoking in Argentina and Uruguay

INTRODUCTION

Cessation of tobacco use has the potential to provide the greatest immediate benefits for tobacco control. Understanding the social determinants of smoking cessation is an essential requirement for increasing smoking cessation at the population level. The purpose of this study was to analyze the socio-economic dimensions associated with cessation success among adults in Argentina and Uruguay.

MATERIAL AND METHODS

Data from the Global Adult Tobacco Survey (GATS), a cross-sectional, population-based, nationally representative survey conducted in Argentina (n=5,383) and Uruguay (n=4,833) was utilized. Univariable and multivariable logistic regression analyses with results being presented as odds ratios (OR) with 95% confidence intervals were applied to study differences among those respondents who sustained smoking abstinence (≥1 year) and those who continued smoking.

RESULTS

The GATS study revealed that social gradients in tobacco quitting exist in Argentina and Uruguay. Being aged 25-34, particularly men in Uruguay, women in Argentina, low educated men in Argentina and having a lower asset index were associated with reduced odds for quitting.

CONCLUSIONS

Factors that are driving differences in smoking cessation between diverse social groups in Latin America countries need to be considered when implementing relevant interventions to ensure tobacco control strategies work effectively for all population segments.

The risk of plasma vitamin A, C, E and D deficiency in patients with metabolic syndrome: A case-control study

BACKGROUND

The increasing incidence of metabolic diseases such as obesity or diabetes have made them a major public health problem. Increasing oxidative stress induced by reactive oxygen species, which initiate the oxidative adverse changes in the cell, is mentioned, among other risk factors, to underlie these diseases. Vitamin A, C and E are listed among the non-enzymatic mechanisms counteracting this phenomenon. Vitamin D deficiency is also associated with cardiovascular diseases.

OBJECTIVES

The aim of the study was to assess the risk of vitamin A, C, E and D deficit in the plasma of metabolic syndrome (MS) patients.

MATERIAL AND METHODS

The study included 191 patients with MS and 98 subjects without MS. Loglinear analysis was used in the assessment of mutual interactions between the vitamin concentration and the analysis of classification by ROC curves to predict the frequency of vitamin deficiency in MS patients.

RESULTS

A correlation was found between the plasma level of vitamins in the group of MS patients. Vitamin A concentration correlated with that of vitamin C (r = 0.51, p = 0.0000), vitamin D (r = 0.49, p = 0.0000) and E (r = 0.32, p = 0.0001). The plasma level of vitamin D correlated with the level of vitamin E (r = 0.46, p = 0.00000) and vitamin C (r = 0.37, p = 0.0000). Regression analysis showed a correlation between the concentration of the tested vitamins in patients with MS. Interactions were observed between vitamins C and A and between C and D. HDL cholesterol level was lower in patients with vitamin A deficiency compared to patients with its normal level.

CONCLUSIONS

The plasma levels of vitamin A, C, E and D were significantly lower in patients with MS than in healthy subjects and they mutually correlated with each other. The normalization of glucose and HDL level may contribute to the regulation of the concentration of vitamin A in patients with MS.

[The incidence of accidents at work among paramedics in the years 2001-2013 based on the register of one selected hospital]

BACKGROUND

Paramedics are exposed to a number of factors that may have a direct or indirect impact on the risk of an accident at work. The aim of the study was to analyze the incidence of accidents at work among paramedics as well as to discuss risk factors and measures to prevent such cases.

MATERIAL AND METHODS

The data on accidents at work were obtained from unpublished internal hospital documentation. The results were subjected to statistical analysis.

RESULTS

In the years 2001-2013 there were 40 events, including 6 collective accidents, in which 41 paramedics of the emergency department were injured. On average, around 3 accidents involving paramedics occurred each year. The accidents happened most frequently in the evening and at night and in the winter months (statistically insignificant relationship). Incorrect behavior of the paramedics was the most common cause of an accident (75.6%) and musculoskeletal injuries (75%) most frequently of upper and lower limbs (55%) were the most common effects of an accident. In none of the cases safety regulations were breached by employees or employer.

CONCLUSIONS

Accidents among paramedics can be prevented by changing the interior design of and the medical equipment installation in the rear cabin of the ambulance, conducting regular training to upgrade the skills of paramedics and enriching their knowledge about health and safety in their widest meaning. Med Pr 2016;67(2):213-221.

[Estimation of cardiovascular risk in patients with metabolic syndrome]

Metabolic syndrome (MS) is a coexistence of metabolic risk factors affecting development of cardiovascular diseases. The SCORE system estimates fatal cardiovascular disease events over a ten-year period.

AIM

The aim of the study was to estimate cardiovascular risk in patients with symptoms of MS.

MATERIALS AND METHODS

The study included 268 patients with symptoms of MS according to International Diabetes Federation criteria (2005), 136 men and 132 women, mean age 59,62±9,21 years. The cardiovascular risk was estimated on based of pulse pressure and SCORE table in these patients.

RESULTS

In subjects with MS the mean value of pulse pressure (pp) was 58,96±2,34 mmHg, increased values of pp was found in 33,21% subjects with MS. High and very high cardiovascular death risk occurred in 80,97% subjects with MS, significantly more often in men than women.

CONCLUSIONS

In majority of patients with MS high cardiovascular risk was found. In every three subjects with MS high pulse pressure was stated.

Lower Plasma Levels of Antioxidant Vitamins in Patients with Metabolic Syndrome: A Case Control Study

BACKGROUND

Metabolic syndrome (MS) is a coexistence of metabolic risk factors affecting the development of cardiovascular diseases. Reactive oxygen species, which are excessively produced in MS, participate in its pathogenesis. Vitamins A, C and E are an important part of the non-enzymatic antioxidative barrier in humans.

OBJECTIVES

The aim of the study was to estimate plasma vitamin A, C and E levels and the intake of these vitamins from the diet in patients with MS.

MATERIAL AND METHODS

The study included 182 patients with MS, 94 men and 88 women, aged 30-65 years (mean 57.31 ± 8.28 years). The control group was comprised of 91 subjects, 56 men and 35 women, aged 41-65 years (mean 57.75 ± 5.84 years). The MS diagnosis was based on IDF criteria. The determination of the serum level of vitamin A, C and E was performed using the spectrophotometric method. The food intake was assessed by 24-h dietary recall.

RESULTS

The mean plasma vitamin A, C and E levels were significantly lower in MS patients than in the controls (p = 0.05). No correlation was found between vitamin A, C and E intake from the diet and their plasma concentrations in MS patients. Plasma vitamin A, C and E deficiency was observed significantly more often in MS patients than in the control group (15.38% vs. 2.19%, 79.12% vs. 8.79% and 60.45% vs. 5.49%, p < 0.0001, respectively). BMI was the one factor significantly affecting the mean value of vitamin A, C and E levels in MS patients.

CONCLUSIONS

MS patients demonstrated significantly lower plasma levels of vitamin A, C and E compared to the healthy subjects. Lower plasma levels of antioxidant vitamins with their high intake from the diet indicate antioxidant barrier impairment in MS patients.

[Estimation of plasma 25(OH)D vitamin deficiency in patients with metabolic syndrome]

Cardiovascular diseases have been the main cause of mortality in Poland for many years, including premature death and the incidence is systematically growing. These diseases contribute to an increase in the number of disabled people and the cost of medical care. The problem of the so called metabolic syndrome (MS), which includes metabolic risks of atherosclerosis, has been known by doctors for a long time. Results of studies which have been conducted for some years confirm that vitamin D deficiency is a risk factor of MS disorders, including obesity, arterial hypertension, diabetes.

AIM

The aim of the study was to assess plasma 25(OH)D vitamin deficiency in patients with MS.

MATERIALS AND METHODS

The study included 268 patients with MS, 136 men and 132 women, aged 30-65 years (mean 59,62±9,21 years). The study group was divided according to the age and season. The plasma level of 25(OH)D above 30 ng/ml was considered normal, between 21 ng/ml and 30 ng/ml - suboptimal (hypovitaminosis) and below 20 ng/ml - insufficient (deficiency).

RESULTS

Plasma 25(OH)D vitamin deficiency was observed in 80,97% patients with MS, hipovitaminosis - in 17,16%. The recommended 25(OH)D concentration in the plasma was confirmed only in 1,87%. Plasma 25(OH)D vitamin deficiency was detected more often in men than women (93,38% vs. 68,18%, p<0,05);the lowest percentage of patients with 25(OH)D vitamin deficiency was observed during summer months (47,14%).

CONCLUSIONS

Plasma 25(OH)D vitamin deficiency was very high in patients with metabolic syndrome, especially in men, people over 55 years and during winter months.

Occupational exposure and health problems among Polish denturists: a population-based study in Łódź province

OBJECTIVE

The aim of this study was to analyse the potential health effects of occupational exposure of denturists in the Łódź province.

METHODS

The survey was performed among 103 denturists working in 24 dental laboratories in the Łódź province using the questionnaire prepared by the authors.

RESULTS

The most common health problems associated with work (occurring daily or at least once a week) were: back pain (69.8%); chronic fatigue syndrome (61.6%); irritation, itching and rashes on the hands (51.2%); restlessness and aggression (43.0%); and watery and itchy eyes (41.9%). Psychosocial and ergonomic hazards associated with work organisation (72.2%) were the most common work environment factors related to the denturist profession.

CONCLUSIONS

Analyses of denturists' occupational exposure in the Łódź province and epidemiological estimates of the health effects suggest the need for preventive measures.

Should antioxidant vitamin supplementation be applied in patients with metabolic syndrome? A case-control study

INTRODUCTION

All cells in the human body are exposed to reactive oxygen species (ROS), which disturb the metabolic reactions in the organism. The antioxidant system in the human body consists of enzymatic and non-enzymatic mechanisms, among which vitamins A, C, and E play a major role.

THE AIM OF THE STUDY

The aim of the study was to evaluate the supply of vitamins A, C, and E from daily food rations (DFR) in postmenopausal women with metabolic syndrome (MS) in relation to current nutrition standards.

MATERIAL AND METHODS

The study involved 184 women with MS, aged 45-68 years (mean 57.38 ±8.17 years). The control group comprised 90 women, aged 41-65 years (mean 57.48 ±5.79 years) without MS. The food intake was assessed using 24-hour dietary recalls.

RESULTS

The evaluation of intake of vitamins measured with daily food rations (DFR) demonstrated that the optimal level of 90-110% according to standards was achieved only in 3.62% of women with metabolic syndrome for vitamin A, in 8.88% for vitamin C, and in 11.41% for vitamin E, which was significantly less often found than in the control group (p < 0.001).

CONCLUSIONS

Women with MS are characterised by diversified intake of vitamins A, C and E, and a subgroup of this patients present low level of antioxidant vitamins intake. Supplementation with antioxidant vitamins should be prescribed individually to postmenopausal women with MS.

[Estimation of plasma 25(OH)D vitamin level in residents of Lodz]

Recent evidence for the pleiotropic differentiated effects of vitamin D, coupled with recognition that vitamin D deficiency is common, has revived interest in this hormone. Vitamin D is produced by skin exposed to ultraviolet B radiation or obtained from dietary sources, including supplements. Persons commonly at risk for vitamin D deficiency include those with inadequate sun exposure, limited oral intake, or impaired intestinal absorption.

THE AIM

of this study was to evaluate plasma 25(OH)D level in residents of Lodz.

MATERIALS AND METHODS

The study included 326 residents of Lodz, 156 men and 170 women, aged 30-65 years (mean 57,25±8,24 years). The study group was divided according to the age and season. The concentration of 25-hydroxy vitamin D (25-OH-D) was assessed with the application of the LIAISON® test using chemiluminescent immunoassay (CLIA) technology.

RESULTS

The mean plasma level of 25(OH)D was 24,96±9,84 ng/ml in studied population and it was not significantly higher in women than men (25,24 ±3,31 ng/ml vs. 23,97±3,71 ng/ml, p>0,05); The highest 25(OH)D concentration was noted in the oldest age group (29,12±2,78 ng/ml)and in summer months (33,21±2,91 ng/ml).

CONCLUSIONS

The concentration of vitamin D in the plasma of residents of Lodz was significantly lower than its recommendations. Age and season of the year were the factors strongly affecting the level of 25(OH)D in studied group.

[Evaluation of prevalece of plasma 25(OH)D vitamin deficiency in residents of Lodz]

Only scarce data have been published regarding serum vitamin D status in adult population in Poland. Observational studies have suggested relationship between 25(OH)D deficiency and many diseases, such as cardiovascular diseases, autoimmunological diseases or cancers. Still little is known about plasma 25(OH)D deficiency in Polish healthy adults.

THE AIM

The aim of the study was to assess plasma 25(OH)D vitamin deficiency in residents of Lodz.

MATERIALS AND METHODS

The study included 326 residents of Lodz, 156 men and 170 women, aged 30-65 years (mean 57,25±8,24 years). The study group was divided according to the age and season. The plasma level of 25(OH)D above 30 ng/ml was considered normal, between 21 ng/ml and 30 ng/ml - suboptimal (hypovitaminosis) and below 20 ng/ml - insufficient (deficiency).

RESULTS

Plasma 25(OH)D vitamin deficiency was observed in 23,01% participants, hipovitaminosis - in 46,32%, the recommended 25(OH)D concentration in the plasma was observed only in 30,67%. Plasma 25(OH)D vitamin deficiency was observed more often in men than women (25,64% vs. 20,59%, p<0,05);the highest percentage of patients with recommended 25(OH)D vitamin level was observed during summer months (60%).

CONCLUSIONS

Plasma 25(OH)D vitamin deficiency was very high in residents of Lodz, especially in men, people over 55 years and during winter months.

[Estimation of plasma 25(OH)D vitamin level in patients with metabolic syndrome]

Cardiovascular diseases are a major public health problem in developed and developing countries. A number of recent studies point to the pleiotropic differentiated effects of vitamin D, the deficiency of which positively correlates with the increased risk for cardiovascular diseases, hypertension, dyslipidemia, obesity or metabolic syndrome (MS). Vitamin D deficiency has also been proven to affect the progression of atherosclerosis.

THE AIM

of this study was to evaluate plasma 25(OH)D level in patients with MS.

MATERIALS AND METHODS

The study included 268 patients with MS, 136 men and 132 women, aged 30-65 years (mean 59,62±9,21 years). The study group was divided according to the age and season. The concentration of 25-hydroxy vitamin D (25-OH-D) was assessed with the application of the LIAISON® test using chemiluminescent immunoassay (CLIA) technology.

RESULTS

The mean plasma level of 25(OH)D was 14,56±7,81 ng/ml in MS patients and it was not significantly higher in women than men (15,14 ±3,29 ng/ml vs. 13,97±3,41 ng/ml, p>0,05). The lowest 25(OH)D concentration was noted in the oldest age group (9,24±4,78 ng/ml). The highest 25(OH)D concentration was noted in summer months (23,71±3,82 ng/ml).

CONCLUSIONS

The concentration of vitamin D in the plasma of patients with MS was significantly lower than its recommendations. Age and season of the year were the factors strongly affecting the level of 25(OH)D in MS patients.

Head Trauma in Elderly Patients: Mechanisms of Injuries and CT Findings

BACKGROUND

Head injuries in elderly people are a common cause of hospitalization at emergency departments. This group of patients is at high risk of post-traumatic intracranial pathology, which is diagnosed by computed tomography (CT) scanning of the head.

OBJECTIVES

The aim of this study was to determine the incidence and outcomes of head trauma in older people in different scenarios, on the basis of CT scan findings.

MATERIAL AND METHODS

The study involved a retrospective analysis of medical records of patients treated in the Emergency Department of Copernicus Memorial Hospital in Lodz, Poland, between the years 2010-2012. Patients above 75 years old whose diagnoses were coded with ICD-10 codes S00-S09 were included in the study. The patients' age, gender, the mechanism and cause of injury, their Glasgow Coma Scale (GCS) score at admission and the results of their head CTs were analyzed.

RESULTS

A total of 301 patients were included in the analysis. Intracranial abnormalities caused by trauma were detected in 24 patients (8%). Transient loss of consciousness (TLOC) was a cause of injury in 44 patients (14.6%) and was related to an increased risk of an abnormal CT scan result (OR 4.6, 95% CI, 1.2-18.4, p < 0.003). Other mechanisms related to an increased risk of post-traumatic intracranial pathology were high-energy mechanisms of injury and unexplained falls.

CONCLUSIONS

Ground-level falls are the most frequent mechanism of head trauma in older people. One of the most commonly identified mechanisms of a fall is TLOC. Head injuries due to TLOC entailed a high risk of intracranial pathology in the elderly population. The risk of trauma-related positive CT scans in patients with unexplained falls is high, and is similar to that observed in patients with TLOC. The highest risk of trauma-related positive CT scans is observed in patients who have suffered a high-energy trauma.

Dental awareness and oral health of pregnant women in Poland

OBJECTIVES

The level of dental awareness of a pregnant woman affects the sanitary condition of her own teeth and the health of the child to be born. Poor oral health is considered to be a probable risk factor for the pre-term birth or low birth weight. The aim of this work was to assess the level of oral health knowledge that determines oral health condition of pregnant women in Poland.

MATERIAL AND METHODS

Empirical data were obtained from the National Monitoring of Oral Health and Its Determinants, financed by the Ministry of Health. This socio-epidemiological study assessed oral health status and dental health awareness, which affects that status. Study subjects included 1380 pregnant women at the age ranging from 15 to 44, randomly-selected from urban and rural environments. Dental health status was recorded in the clinical examination sheets supplied by the World Health Organization, and the socio-medical data were recorded in the questionnaire interview sheets.

RESULTS

Almost 3/4 of the pregnant women evaluated their dental health as unsatisfactory or poor. Over 60% of the pregnant women rated their knowledge and practical skills concerning care of their own teeth and of the child to be born as limited, inadequate or none. Only 40% of the pregnant women provided right answers to the questions about dental issues.

CONCLUSIONS

Low oral health awareness results in poor oral health status of the study subjects. A statistical pregnant woman has a total of 13 teeth showing the symptoms of tooth decay or caries. Over 70% of the pregnant women developed gingivitis or periodontitis. There is an urgent need in Poland to make the European principle of treating pregnant women as a dentally vulnerable group obligatory.

[Physical activity in patients with symptoms of metabolic syndrome reduces the concentration of plasma antioxidant vitamins - protective effect of vitamin C]

Patients with cardiovascular diseases, including those with the symptoms of metabolic syndrome (MS), are recommended regular exercise but many studies indicate its role in the production of reactive oxygen species. Vitamin C supplementation may enhance the antioxidant barrier in MS patients.

AIM

The aim of the study was to assess the impact of regular physical activity (PA)and vitamin C supplementation on plasma vitamin A, C and E levels in patients with MS.

MATERIALS AND METHODS

The study included 62 patients with MS according to International Diabetes Federation criteria, 32 men and 30 women, aged 38-57 years (mean age 51,24 ± 5,29 years). The patients were divided in two groups: group I (MS+PA) - 31 patients with recommended regular physical activity; group II ( MS+PA+C) - 31 patients with recommended regular physical activity and vitamin C supplementation per os. The control group consisted of 23 healthy individuals without MS, 17 men and 6 women, aged 49-56 years (mean age 53,21 ± 3,6 years), who were not recommended any vitamin supplementation nor physical activity. Plasma vitamin A, C and E levels were estimated in MS patients with spectrophotometry using T60V spectrophotometer (PG Instruments) before and after regular exercise with and without vitamin C supplementation. In the control group plasma levels of antioxidant vitamins were assessed only once.

RESULTS

The plasma vitamin A, C and E levels were significantly lower (p<0,05) in MS patients than in the control group. After 6 weeks of regular physical activity a significant fall in plasma levels of antioxidant vitamins was observed in MS patients. In the group of patients with regular physical activity and vitamin C supplementation there was detected a significant rise in the level of all the tested vitamins close to the levels in control group.

CONCLUSIONS

Regular physical activity enhances the decrease in plasma antioxidant vitamin level in patients with MS. Vitamin C supplementation conducted in parallel with regular physical activity normalize plasma vitamin A, C and E levels in these patients.

Assessment of 25(OH)D vitamin concentration in plasma of residents of Lodz with metabolic syndrome in pre- and postmenopausal period

INTRODUCTION

Vitamin D deficiency is a risk factor for metabolic syndrome disorders and the occurrence of these disorders greatly contributes to the deficiency of vitamin D. Postmenopausal women are particularly prone to that deficiency.

AIM

The aim of the study was to assess vitamin D concentration in the plasma of pre- and postmenopausal women, with or without metabolic syndrome.

MATERIAL AND METHODS

The study included 141 women aged 26-77 (the mean age 58.74 years old), divided into 4 groups depending on the pre- or postmenopausal period and diagnosed or not with metabolic syndrome according to the International Diabetes Federation criteria (2005). Vitamin D concentration was assessed by LIAISON(®) test using chemiluminescent immunoassay (CLIA) technology.

RESULTS

The mean vitamin D concentration was the highest among premenopausal women without metabolic syndrome (24.32 ng/ml), it was insignificantly higher than in postmenopausal women without metabolic syndrome (23.52 ng/ml) and significantly higher than in both groups with metabolic syndrome - premenopausal (19.86 ng/ml) and postmenopausal women (9.32 ng/ml). The recommended plasma 25(OH)D concentration was not found in any of postmenopausal women with diagnosed metabolic syndrome.

CONCLUSIONS

Postmenopausal women with metabolic syndrome had a significantly lower 25(OH)D vitamin concentration in plasma than postmenopausal women without metabolic syndrome. The frequency of vitamin D deficiency in women with metabolic syndrome was very high, significantly higher than in women without metabolic syndrome.

[Estimation of plasma vitamin A, C and E levels in patients with metabolic syndrome]

Metabolic syndrome (MS) is a coexistence of metabolic risk factors affecting development of cardiovascular diseases. In the pathogenesis of MS there participate reactive oxygen species which are excessively produced in such elements of MS as hyperglycemia, insulin resistance and obesity. Vitamins A, C and E are an important part of the non-enzymatic antioxidative barrier in humans. The aim of the study was to estimate plasma vitamin A, C and E levels in patients with symptoms of MS.

MATERIAL AND METHODS

The study included 68 patients with symptoms of MS according to International Diabetes Federation criteria (2005), 37 men and 31 women, aged 34-65 years (mean age 57, 76 +/- 8, 29 years). The control group consisted of 24 healthy individuals without MS, 18 men and 6 women, aged 49-67 (mean age 58, 5 +/- 5, 6 years). Plasma vitamin A, C and E levels were estimated in patients and the control group with spectrophotometry using T60V spectrophotometer (PG Instruments).

RESULTS

The plasma vitamin A, C and E levels were significantly lower (p < 0.05) in MS patients than in the healthy individuals without symptoms of MS. The most significant differences in the level of antioxidative vitamins in both groups were related to vitamin C and vitamin E.

CONCLUSIONS

The decreased level of vitamins A, C and E points to the weakening of antioxidative barrier in patients with MS.

Thirty years of evolution of oral health behaviours and dental caries in urban and rural areas in Poland

INTRODUCTION AND OBJECTIVE

34 years ago, children living in rural areas had almost 2 more teeth affected by decay than those living in cities. Environmental differences are being reduced along with Poland's civilization development. The aim of the study is to assess the extent to which the differences in the intensity of caries and oral health behaviours between the urban rural environment have been reduced have been reduced in the past 3 decades.

MATERIALS AND METHODS

The data from 9 national surveys of 14,338 children aged 12 years and 5,425 adults aged 35-44 who lived in the city and in the countryside were analysed. Mean number of decayed (D), missing (M) and filled (F) teeth (DMFT) was determined during the examination, as well as oral health behaviours.

RESULTS

During the past 3 decades, in the statistical 12-year-old Polish child, tooth decay has been reduced from 7.3 to 3.6 teeth, and the environmental difference between the town and village children is now almost 5 times smaller. A similar trend is observed in children's dental behaviours. Improving the oral health status and levelling of the environmental differences in the population aged 35-44 is much slower than in children.

CONCLUSIONS

In the last three decades, the level of tooth decay has been reduced by half, but it is still 3 times higher than in other European countries. Environmental differences have been reduced particularly in children. Both the oral health status and urban/rural environment differences in the intensity of tooth decay may be regarded as one of the many measures of Poland's social and civilization development. However, the analysed process is not monotonic; instead, it has some turning points.

A randomised comparison between Cobra PLA and classic laryngeal mask airway and laryngeal tube during mechanical ventilation for general anaesthesia

BACKGROUND

The aim of this study was to compare ventilation parameters during mechanical ventilation using Laryngeal Mask Airway (LMA), Laryngeal Tube (LT), and Peri-Laryngeal Airway Cobra (PLA).

METHODS

In a prospective, randomised controlled trial, 90 patients undergoing general anaesthesia for elective surgery were divided into three subgroups. The settings of controlled ventilation were: oxygen 50%, air 50%, sevoflurane 1.5-2.0%, TV 7 mL kg(-1), RR 10 breath min(-1), inspiratory/expiratory ratio 1:2 and FGF 3 L min(-1). The number of attempts, time taken to insert the device, airway pressure (peak airway pressure, plateau airway pressure), air leak (inspiratory and expiratory volume difference), and dynamic compliance were measured. The timepoints for collecting data were after successful insertion of the device, and after ten, 20, 30 and 50 mins of ventilation. The presence of visible blood traces, patients' assessment of their throat soreness, dysphonia and dysphagia were noted postoperatively.

RESULTS

The success rates at first insertion were 90% and 80% and 90%, while time for insertion was 5 sec and 21.94 sec and 5.24 sec in the Cobra PLA, LMA and LT groups respectively. Ventilation pressures during procedure were highest in the LT group, where compliance was lowest compared to the Cobra PLA and LMA groups. The air leak was similar in all the groups. 30% vs. 40% vs. 10% of devices had positive blood traces; 20% vs. 40% vs. 30% of patients suffered from a sore throat; and 30% vs. 30% and 30% of patients suffered from dysphagia in the Cobra PLA, LMA and LT groups respectively.

CONCLUSION

The differences were small, but Cobra PLA seemed to be slightly superior in terms of the measured parameters.

[Evaluation of soft tissue changes after mandibular prognathism surgery]

Therapeutic goals for orthognathic surgery are not only directed towards the correction of dento-osseous deformieties but also to provide the optimal functional and esthetic effect that results in patients satisfaction. THE AIM OF THE STUDY was to evaluate soft tissue changes following surgical treatment of patients with mandibular prognathism operated with two alternative techniques: extraoral vertical ramus osteotomy or sagittal split ramus osteotomy.

MATERIAL AND METHODS

A sample of 37 patients with mandibular prognathism operated in Cranio-Maxillofacial Department. The patients included in the study underwent isolated surgery within mandibular rami, without any adjunctive procedures. Long-term and early outcomes of soft tissue changes following surgery were monitored by means of cephalometric analysis according to Arnett in consecutive intervals: before surgical treatment; 1 to 2 weeks after surgery; 6 months and 12 months after surgery. Study variables included age, gender and method of surgical treatment.

RESULTS

In both groups operated with bilateral sagittal osteotomy and extraoral vertical ramus osteotomy methods increase of A'-B' value in T2, T3 i T4 comparing values in T1 was recorded. Immediately and 12 months after both surgeries increase of ULA-LLA, and 6 months after bilateral sagittal osteotomy statistically significant decrease of this parameter compareing with values before surgery was noted. Greater decrease of ULA-LLA value was found from 6 to 12 months postoperatively in female group, final change of ULA-LLA value 12 months after surgery in female group was greater.

CONCLUSIONS

Both surgical technics of mandibular setback results in improvement in lower part of the face, although precise analysis of soft tissue profile changes reveals differences. In women skeletal changes caused greater changes within soft tissue than in men.

[Complications of surgical treatment of mandibular prognathism]

Negative emotions due to violate facial appearance resulting from dentofacial disharmony may affect psychological status and general life adjustment of the patient. This is the origin of clinicians' great responsibility for satisfying result of surgical treatment in patients with mandibular prognathism. The aim of the study was evaluation of incidence of intraoperative and postoperative complications during surgical treatment of mandibular prognathism with bilateral mandibular sagittal ramus osteotomy or mandibular bilateral vertical ramus osteotomy and defining predisposing factors.

MATERIAL AND METHODS

A sample of 37 patients with mandibular prognathism operated in Department of Cranio-Maxillofacial Surgery in Lódź from May 2001 to February 2006 was included into the study. The patients were underwent surgery with mandibular bilateral sagital osteotomy (intraoral approach) or mandibular vertical ramus osteotomy (extraoral approach). Demographic data (gender and age) and medical data (method of surgery, time of hospitalization) were collected. Intraoperative and postoperative complications were recorded as well acceptance of scar.

RESULTS

Facial nerve paralysis immediately after surgery and 6 months after surgery was observed in group of patients operated with vertical ramus osteotomy (6 and 3 patients respectively to time), and released completely after 12 months. Early and permanent paraesthesia was recorded more often in group of patients operated with sagittal split ramus osteotomy (respectively 14/17 and 2/17 for early and permanent paraesthesia) in contrast to 3 of 20 patients operated with vertical ramus osteotomy. Permanent (12 months postoperatively) paraesthesia within third branch of trigeminal nerve were diagnosed more often in patients over 25 years old. 3 patients operated with sagittal split ramus osteotomy demonstrated unilateral wound healing problems and 4 patients operated with vertical ramus osteotomy demonstrated wound healing problems and it was related to unacceptable cicatrix.

CONCLUSIONS

1. Frequency of intraoperative and postoperative complications in surgical treatment of mandibular prognathism is independent on patients' gender and age. 2. The choice of sagittal split ramus osteotomy is related to higher probability of paraesthesia within lower lip immediately after surgery, but the early risk of facial nerve paralysis is greater after extraoral vertical ramus osteotomy.

[Pneumosinus dilatans: method of treatment]

INTRODUCTION

Pneumosinus dilatans--progressive hyperpneumatisation is a very rare condition, most often frontal sinuses are involved.

MATERIAL AND METHODS

One male patient with a pneumosinus dilatans of frontal sinus is presented. The main complaint was moderate pain during motorcycling. Based on the review of the literature and analysis of the new case clinical findings, possible aetiologies and surgical management are discussed.

RESULTS

An aesthetic and functional result is stable.

CONCLUSIONS

1. Etiology of pneumosinus dilatans is still controversial and the low frequency enables systematic studies. 2. Surgical management presented in the article is effective and relatively not complicated.

A method for determination of tongue size in patients with mandibular prognathism

INTRODUCTION

The view on the role of the tongue in the etiology of dentofacial malformations and relapse after orthognathic surgery has changed over years.

PURPOSE

The aim of this study was to determine the clinical and metric size of the tongue in patients with madibular prognathism in comparison with persons with normal face anatomy.

MATERIALS AND METHODS

A noninvasive study was conducted at the Department of Cranio-Maxillofacial Surgery, Medical University in Lódź. We enrolled 152 patients and divided them into two groups: I - study group with mandibular prognathism, II - control group without dentofacial malformations.

RESULTS

Statistical analysis revealed significant differences between the clinical size of the tongue in the study and control groups. A large tongue was more often detected in the study than the control group. The frequency of small tongue was similar in both groups.

CONCLUSIONS

Patients with mandibular prognathism have a larger tongue in comparison with normal individuals.